acenocoumarol and Myocardial-Infarction

Anticoagulant treatment is required for the treatment and prevention of thromboembolic disorders. Vitamin K antagonists are commonly used oral anticoagulants worldwide. Acenocoumarol is mono-coumarin derivative with racemic mixture of R (+) and S (-) enantiomers. Efficacy and safety of acenocoumarol has been evaluated in atrial fibrillation, cardiac valve replacement, after myocardial infarction, treatment of deep vein thrombosis, after major surgeries and after critical illness requiring prolonged hospitalization. Acenocoumarol is effective and safe in all age groups. It offers an advantage over warfarin in terms of better stability of anti-coagulant effect. Due to its economic advantage acenocoumarol may be suitable oral anticoagulant for long term use in countries like India.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Atrial Fibrillation; Humans; India; Mixed Function Oxygenases; Myocardial Infarction; Thromboembolism; Treatment Outcome; Vitamin K

Topics: Acenocoumarol; Angina Pectoris; Anticoagulants; Cerebrovascular Disorders; Dicumarol; Heparin; Humans; Myocardial Infarction; Phlebitis; Rheumatic Heart Disease; Thromboembolism; Thrombophlebitis; Warfarin

Stent prosthesis is a high efficacious method with low complication rates. However, the ideal adjunctive therapy following stent implantation remains controversial. The authors compared the effectiveness and complication rates of aspirin-ticlopidine antiplatelet therapy vs. anticoagulant therapy with acenocoumarol within 30 days following stent prosthesis. They prospectively studied 404 patients following stent prosthesis while randomly receiving anticoagulant (Group A: 201 patients) vs. antiplatelet treatment (Group B: 203 patients). Groups A and B were similar in demographic data (age, gender), stent location, clinical presentation, indication of stenting, and type of implanted stent. Chi-square test, t test, and Wilcoxon test for two samples were used for statistical analysis of the results. Stent implantation was attempted in 434 cases. This was successful in 70/85 (82%) of the bailout, 122/135 (90%) of the suboptimal, and 212/214 (99%) of the elective cases. In 201 patients anticoagulant treatment with acenocoumarol was administered for 4 weeks (group A), while 203 received antiplatelet treatment with ticlopidine (group B). The need for reintervention was less and total cardiac events were fewer in group B than in group A: three (1.5%) and nine (4.4%) vs 18 (9%) and 29 (14.4%), p<0.0008 and p<0.006 respectively. Hemorrhagic complications and total noncardiac events were fewer in group B than in group A: six (3%) and six (3%) vs. 18 (9%) and 19 (9.5%), p<0.01 and p<0.007 respectively. The length of hospital stay was shorter in group B than in A, p<0.0001. In conclusion, in this study of intracoronary stenting the authors had a high success rate in 434 attempted cases. Antiplatelet therapy was accompanied by fewer cardiac and noncardiac 1 month events when compared with anticoagulant therapy, supporting its role as the adjunctive treatment of choice post-stenting for the time being.

Topics: Acenocoumarol; Aged; Angina Pectoris; Angioplasty, Balloon, Coronary; Anticoagulants; Aspirin; Coronary Disease; Female; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Prospective Studies; Stents; Ticlopidine

The authors examined the bleeding complications in 75 patients who received acenocoumarol and acetylsalicylic acid combined therapy. The studied population suffered from either acute myocardial infarction or unstable angina. Among the 75 patients in two cases (2.7%) appeared serious bleeding and in another 25 cases (33.3%) mild bleeding complications. There were no fatal cases. Comparing these data with literary data, the authors stated that in the study group the proportion of serious complications didn't increase in comparison with patients who received either acenocoumarol, warfarin or acetylsalicylic acid but mild bleeding appeared more frequently. This finding suggests that in high risk patients the combined acenocoumarol-acetylsalicylic acid therapy can be considered under strict control.

Topics: Acenocoumarol; Angina, Unstable; Aspirin; Drug Synergism; Drug Therapy, Combination; Female; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Prothrombin; Warfarin

Various methods have been described to evaluate efficacy of anticoagulant therapy using the international normalized ratio (INR). We compared the following approaches: (1) total INR's or the most recent measurement; (2) percent time within therapeutic range, with INR changing directly or halfway between visits; and (3) total observation time assuming INR changing linearly. The study population comprised 1700 post myocardial infarction patients. Treatment comprised 3725 patient-years. There were 61,471 INR assessments with target therapeutic level of 2.8-4.8. Acenocoumarol as well as phenprocoumon were employed. Therapeutic achievement in the first months of treatment was low: less than 60% of INR's were in range. Treatment stabilized after 6 months. Patients on acenocoumarol were within range 70% of the time compared to 80% for phenprocoumon. Method 3 is preferred because it incorporates time and is capable of calculating incidence rates at different INR levels. Our findings call for an urgent improvement of standard of anticoagulant control in the first months following commencement of treatment.

Topics: Acenocoumarol; Aged; Anticoagulants; Cardiovascular Diseases; Convalescence; Double-Blind Method; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Phenprocoumon; Prothrombin Time; Quality Control; Reference Standards; Thromboplastin; Treatment Outcome

The use of long-term oral anticoagulant treatment after myocardial infarction remains controversial because of conflicting findings on mortality in previous trials and the increased risk of bleeding associated with anticoagulants. We have carried out a randomised, placebo-controlled, double-blind, multicentre trial in 3404 hospital survivors of myocardial infarction. Eligible patients were randomly assigned to anticoagulant (nicoumalone or phenprocoumon) or placebo treatment within 6 weeks of discharge. The target prothrombin time was 2.8-4.8 international normalised ratio. During mean follow-up of 37 (range 6-76) months there were 170 deaths among 1700 anticoagulant-treated patients and 189 in 1704 placebo-treated patients (hazard ratio 0.90 [95% CI 0.73-1.11]). Anticoagulant treatment led to significant reductions by comparison with placebo treatment in recurrent myocardial infarction (114 vs 242 patients; hazard ratio 0.47 [0.38-0.59]) and cerebrovascular events (37 vs 62; 0.60 [0.40-0.90]). Major bleeding complications were seen in 73 patients who received anticoagulants and 19 who received placebo. We conclude that long-term oral anticoagulant treatment after myocardial infarction in low-risk patients has a limited effect on mortality but achieves substantial benefit by reducing the risk of cerebrovascular events and recurrent myocardial infarction.

Topics: Acenocoumarol; Administration, Oral; Aged; Cardiovascular Diseases; Cause of Death; Double-Blind Method; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Phenprocoumon; Proportional Hazards Models; Recurrence; Risk Factors; Survival Rate

This study was designed to assess, by two-dimensional echocardiography, the effects of anticoagulant therapy on left ventricular thrombosis detected after acute myocardial infarction. Thirty-eight patients with left ventricular thrombi detected by two-dimensional echocardiology within 5 weeks (mean 4) of the onset of infarction were randomly assigned to the following groups: group A consisted of 19 patients who received oral anticoagulants (acenocoumarin 1-6 mg daily regulated to keep prothrombin time within the range of 25 to 35%) and group B which consisted of 19 non-treated control patients. Seventeen patients from both groups were restudied 15 days, 3 months and one year later to evaluate the changes in size of thrombi. Echocardiographic examinations were read blindly; a significant decrease in ventricular thrombus size was taken as a greater than or equal to 5 mm reduction of thickness in the apical views. In Group A, 9 patients showed a complete resolution of thrombus at the 15 day study; at one year, thrombus had resolved in 15 and persisted unchanged in size in 2 patients. The mean dimension of thrombi in patients of group A was 18 +/- 6.6 mm at the screening examination and decreased to 6.6 mm, 3.8 mm and 2.2 mm, respectively, at 15 days, 3 months and one year follow-up studies. Among 17 patients of group B at the 15 day study, two had resolution of thrombus and 15 were unchanged; at the one year examination thrombus was resolved in 4, decreased in size in 4 and persisted unchanged in 9 patients. Analysis of variance of the dimensional changes of thrombi in the two groups of patients confirmed a significant efficacy of anticoagulant therapy (P less than 0.001). On the basis of our results we conclude that full-dose anticoagulant therapy, started early (within 5 weeks) after acute myocardial infarction, is effective in the resolution of left ventricular thrombosis.

Topics: Acenocoumarol; Adult; Aged; Clinical Trials as Topic; Echocardiography; Follow-Up Studies; Heart Diseases; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Random Allocation; Thrombosis

Topics: Acenocoumarol; Adult; Ambulatory Care; Aspirin; Clinical Trials as Topic; Coronary Disease; Dipyridamole; Follow-Up Studies; Humans; Middle Aged; Myocardial Infarction; Recurrence

In a randomized double blind clinical trial, we compared indobufen, an antiplatelet drug, with acenocoumarol for the prevention of deep venous thrombosis (D.V.T.) in patients with acute myocardial infarction. Therapy was started on admission and continued for 10 days. All patients were screened daily with impedance plethysmography (I.P.G.) and 125I-fibrinogen leg scanning. Diagnosis of D.V.T. was made when either one or both tests became positive. 74 patients were randomized to treatment with indobufen (200 mg b.i.d.) and 76 patients to acenocoumarol (controlled by thrombotest). The incidence of venous thrombosis in patients with indobufen was 11% and in those treated with acenocoumarol 9%. Major bleeding was observed in 2 patients treated with acenocoumarol. In the indobufen group, no bleeding complications or other serious side-effects were observed. The majority of patients developed thrombosis after the first week of admission. For patients with and without thrombosis, there was no significant difference between the two treatment groups concerning the age, the coronary prognostic index, the maximum C.P.K. value, mobility, incidence of congestive heart failure and the site or extent of the infarct. In this study no clinical or laboratory (fibrinogen, platelet count and anti-thrombin III) parameter, either alone or in combination, was of predictive value for the development of D.V.T. It can be concluded that indobufen appears to be as good as acenocoumarol for the prevention of D.V.T. in patients with acute myocardial infarction. Because it is safe and easy to administer, indobufen seems to be preferable. Prophylaxis is required for at least 10 days.

Topics: Acenocoumarol; Aged; Antithrombin III; Female; Fibrinogen; Humans; Isoindoles; Leg; Male; Middle Aged; Myocardial Infarction; Phenylbutyrates; Platelet Count; Plethysmography, Impedance; Radionuclide Imaging; Thrombophlebitis

To investigate the possible clinical interaction between the platelet function regulator sulphinpyrazone (SP) and the oral anticoagulant acenocoumarol (AC), 22 in-patients of either sex were included in a single blind within-patient trial vs. placebo. After one week of stabilizing treatment with AC alone the patients were randomly allocated to two sequences (11 patients each), either SP + AC for weeks 2--3 followed by placebo + AC for weeks 4--5, or the reverse sequence, i.e. placebo + AC followed by SP + AC for the same periods. 17 patients completed the full five weeks. Four dropped out during SP treatment, all but one following some form of bleeding episode. One patient dropped out for the same reason during placebo. Apart from the bleeding episodes, no other undesirable effects were recorded. The daily dose of SP was always 800 mg. A statistically highly significant interaction (p less than 0.01) between SP and AC was found. The addition of SP to AC led to a drop in mean prothrombin time and rendered necessary a consequent reduction (of about 20%) in mean AC dosage. It is concluded that when initiating and withdrawing treatment with SP in a patient receiving AC, the prothrombin time should be checked daily for a few days to adapt (reduce) the dosage of AC to the change in prothrombin time induced by SP.

Topics: Acenocoumarol; Adult; Aged; Arterial Occlusive Diseases; Blood Coagulation; Clinical Trials as Topic; Drug Interactions; Female; Humans; Male; Middle Aged; Myocardial Infarction; Placebos; Pulmonary Embolism; Sulfinpyrazone; Thrombophlebitis

Topics: Acenocoumarol; Aged; Aspirin; Clinical Trials as Topic; Follow-Up Studies; Humans; Middle Aged; Myocardial Infarction; Platelet Aggregation; Random Allocation; Recurrence

A double-blind crossover trial between diclofenac sodium and placebo was carried out in 32 hospitalized patients who were thought to be stabilized on concurrent anticoagulant therapy with acenocoumarol. The object of the trial was to investigate any possible interaction between diclofenac and anticoagulant by monitoring prothrombin times daily through the four week period. No statistically significant difference between placebo and diclofenac could be shown and some problems of accurately monitoring prothrombin times are discussed.

Topics: Acenocoumarol; Angina Pectoris; Arthritis, Rheumatoid; Diclofenac; Double-Blind Method; Drug Interactions; Electric Countershock; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis

Topics: Acenocoumarol; Aged; Angina Pectoris; Blood Coagulation Tests; Coumarins; Evaluation Studies as Topic; Hemorrhage; Humans; Myocardial Infarction; Time Factors

Topics: Acenocoumarol; Blood Coagulation; Blood Coagulation Tests; Coronary Disease; Coumarins; Female; Humans; Male; Middle Aged; Myocardial Infarction

Topics: Acenocoumarol; Adult; Clinical Trials as Topic; Humans; Male; Middle Aged; Myocardial Infarction; Placebos

The aim of this study was to compare the efficacy of dabigatran 110 mg twice daily and acenocoumarol in patients with atrial fibrillation discharged after ischemic stroke. We prospectively studied 436 consecutive patients who were discharged after acute ischemic stroke (39.2% males, age 78.6 ± 6.7 years). Approximately 1 year after discharge, the functional status was assessed with the modified Rankin scale (mRS). Adverse outcome was defined as mRS between 2 and 6. The occurrence of ischemic stroke, myocardial infarction (MI) and death during the 1-year follow-up was also recorded. At discharge, 142 patients had atrial fibrillation. Acenocoumarol and dabigatran 110 mg twice daily were prescribed to 52.1 and 6.3% of these patients, respectively. At 1 year after discharge, there was a trend for patients treated with acenocoumarol to have lower mRS than patients prescribed dabigatran (2.3 ± 2.4 and 4.1 ± 2.2, respectively; P = 0.060). Adverse outcome rates and the incidence of stroke during follow-up did not differ between the two groups. The incidence of MI was almost three times higher in patients prescribed dabigatran than in those prescribed acenocoumarol, but this difference did not reach significance (11.1 and 4.0%, respectively; P = 0.254). The incidence of cardiovascular death was also almost three times higher in the former, but again this difference was not significant (33.3 and 12.2%, respectively; P = 0.237). In real-world patients with acute ischemic stroke, dabigatran 110 mg twice daily is as effective as acenocoumarol in preventing stroke but appears to be associated with worse long-term functional outcome and higher incidence of MI.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Antithrombins; Atrial Fibrillation; Brain Ischemia; Dabigatran; Drug Administration Schedule; Female; Humans; Male; Myocardial Infarction; Patient Discharge; Prospective Studies; Stroke; Survival Analysis; Thrombosis

Time in therapeutic range (TTR) reflects the quality of anticoagulation and is inversely correlated with ischemic stroke in atrial fibrillation (AF) patients. Few data on the relationship between TTR and myocardial infarction (MI) are available. We investigated the association between TTR and Major Adverse Cardiovascular Events (MACE) in a cohort of anticoagulated AF patients.. We calculated TTR for 627 AF patients on vitamin K antagonists, who were followed for a median of 30.8 months (1755 patients/year). The primary outcome was a combined endpoint of MACE including fatal/nonfatal MI and cardiovascular death.. Mean age was 73.3 (±8.2) years, and 40.2% were women. During follow-up, we recorded 67 events: 19 stroke/TIA (1.1%/year) and 48 MACE (2.9%/year): 24 MI and 24 cardiovascular deaths. The cohort was categorized according to tertiles of TTR values: TTR 13-58%, 59-74%, and 75-100%. There was a significant increased rate of MACE across tertiles of TTR (Log-Rank test: p<0.001). On Cox proportion hazard analysis, the 2nd vs. 1st tertile of TTR (p=0.002, hazard ratio [HR] 0.347, confidence interval [CI] 95% 0.177-0.680), 3rd vs. 1st tertile of TTR (p<0.001, HR 0.164, CI 95% 0.067-0.402), age (p<0.001, HR 1.094, CI 95% 1.042-1.148), history of stroke/TIA (p=0.015, HR 2.294, CI 95% 1.172-4.490) and smoking (p=0.003, HR 3.450, CI 95% 1.532-7.769) predicted MACE.. TTR was an independent predictor of MACE in our cohort of AF patients. Our findings suggest that a good anticoagulation control is necessary to reduce not only the risk of stroke but also that of MACE.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Cardiovascular Diseases; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Myocardial Infarction; Patient Outcome Assessment; Proportional Hazards Models; Prospective Studies; Regression Analysis; Stroke; Vitamin K; Warfarin

Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic progressive disease of pulmonary circulation characterised by indistinct ethiopathogenesis. We present a case of a 50 year-old male with thrombophilia of unknown origin leading to the formation of multiple thrombi within venous circulation followed by episodes of acute pulmonary embolism resulting ultimately in acute heart failure in the course of developing CTEPH. Unfortunately, despite the wide range of haemostasis laboratory tests we were not able to define the type of coagulation abnormality. Owing to the efficient cooperation between cardiologists and cardiosurgeons it was possible to save patient's life.

Topics: Acenocoumarol; Anticoagulants; Cardiac Surgical Procedures; Coronary Thrombosis; Echocardiography, Doppler; Humans; Hypertension, Pulmonary; Intestine, Small; Male; Middle Aged; Myocardial Infarction; Necrosis; Pulmonary Embolism; Stroke; Time Factors; Treatment Outcome; Warfarin

Topics: Acenocoumarol; Aged; Alleles; Drug Resistance; Humans; Male; Mixed Function Oxygenases; Mutation, Missense; Myocardial Infarction; Phenprocoumon; Vitamin K Epoxide Reductases

We present a case of a 58-year-old male being treated for dilated cardiomyopathy and atrial fibrillation for more than ten years who was admitted to the intensive care unit with the diagnosis of acute ST-segment elevation myocardial infarction (STEMI). In course of further diagnostics the coronary artery embolism resulting from the unintentional anticoagulant drug (acenocumarol) dose reduction was established as the most probable cause of STEMI. Primary percutaneous coronary intervention was successfully performed and the patient was discharged home in good clinical condition.

Topics: Acenocoumarol; Angioplasty, Balloon, Coronary; Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Dilated; Coronary Angiography; Coronary Thrombosis; Electrocardiography; Heart Conduction System; Humans; Male; Middle Aged; Myocardial Infarction; Treatment Outcome

Cardiovascular disease is the main cause of death after renal transplantation. There are few trials evaluating the efficacy of prevention strategies in renal transplant patients on major adverse cardiac events (MACE) and cardiovascular mortality. However, there is general agreement that active prevention strategies can significantly decrease cardiovascular mortality after renal transplantation. Here, we present the case of a 52-year-old male patient who received a first kidney transplant in 1993. He showed a small fixed perfusion defect on thallium scintigraphy before transplant. He was admitted at 13 months due to an antero-lateral myocardial infarction that was complicated with ventricular fibrillation. Despite anti-coagulation with acenocumarol, treatment with statins and angiotensin II receptor blocking agents and an excellent preservation of renal function, the patient presented with a second episode of myocardial infarction at 9 years post-transplant. This case report is discussed in order to highlight the way in which attitudes have been modified in the past decade in order to systematically pursue an early diagnosis of pre-existing coronary artery disease, aggressively treat MACE and actively decrease cardiovascular risk in transplant patients, using all available efficacious treatments as well as individualizing immunosuppression to prolong not only graft but also patient survival.

Topics: Acenocoumarol; Amiodarone; Angioplasty; Calcineurin Inhibitors; Carbazoles; Carvedilol; Cyclosporine; Drug Therapy, Combination; Fatty Acids, Monounsaturated; Fluvastatin; Humans; Immunosuppressive Agents; Indoles; Kidney Transplantation; Male; Middle Aged; Myocardial Infarction; Nitroglycerin; Postoperative Complications; Pravastatin; Prednisone; Propanolamines; Risk Factors; Tacrolimus; Treatment Outcome

A 78-year-old man was treated with coumarin derivatives following myocardial infarction. The international normalised ratio was not increased by using standard loading doses and dose adjustments for acenocoumarol and phenprocoumon. The desired level of anticoagulation was achieved with a high dosage of phenprocoumon (18-21 mg daily). This dose was associated with a phenprocoumon serum concentration that was ten times higher than the normal therapeutic concentration. The serum concentration of vitamin K1 was low. After exclusion of alternative causes, we concluded that the exceptionally high dose of phenprocoumon needed was due to partial resistance to coumarin derivatives. Partial resistance is related to a polymorphism of the gene coding for the enzyme vitamin K epoxide reductase. The patient was successfully treated with chronic high-dose phenprocoumon. Resistance to coumarin derivatives caused by a congenital polymorphism in the vitamin K reductase gene is a rare phenomenon. Resistance is seldom absolute. The desired anticoagulation effect can be achieved with doses that are 10-20 times higher than standard doses. Phenprocoumon is advantageous in this situation because it requires fewer tablets than acenocoumarol. Determination of serum concentrations of acenocoumarol and phenprocoumon can be used to exclude other causes of treatment resistance.

Topics: Acenocoumarol; Aged; Anticoagulants; Dose-Response Relationship, Drug; Drug Resistance; Humans; Male; Mixed Function Oxygenases; Myocardial Infarction; Phenprocoumon; Polymorphism, Genetic; Treatment Outcome; Vitamin K; Vitamin K Epoxide Reductases

The incidence of clinically significant thromboembolic events due to the use of cardiac assist device systems remains high. Despite the considerable advances in cardiac assist device technology, the monitoring and management of the hypercoagulable coagulation status, resulting from foreign surfaces of the assist device system, altered rheologic conditions, and blood stasis in the recipient heart remain a challenge. Moreover septic complications and insufficient anticoagulation are responsible for thromboembolic events.. In addition to standard coagulation analysis, functional coagulation tests were performed including the use of a thrombelastographic monitoring system (ROTEG) and a platelet function analyzer (PFA-100).. Severe biventricular ischemic heart failure developed in a 58-year-old man with acute myocardial infarction and he needed a biventricular assist device for a bridge to cardiac transplantation. Although the patient received acenocoumarol (Sintrom; Novartis Pharma, Vienna, Austria) and acetylsalicylic acid (Aspisol; Bayer AG, Leverkusen, Germany) as usual, ROTEG and the PFA-100 detected hypercoagulability while routine coagulation screening tests showed hypocoagulability. Moreover thrombus formation surrounding the canula of the left ventricular assist device was detected. Antithrombotic therapy with clopidogrel (Plavix) was initiated. Coagulation was closely monitored with modified thrombelastography and the PFA-100 to achieve sufficient but not overwhelming anticoagulation therapy. Three months after biventricular assist device implantation the patient underwent successful transplantation with no major blood loss.. Thrombelastography should be the standard form of monitoring in such patients to decrease the risk of thromboembolic events and prevent bleeding complications.

Topics: Acenocoumarol; Angioplasty, Balloon, Coronary; Anticoagulants; Aspirin; Blood Coagulation; Blood Coagulation Tests; Drug Administration Schedule; Drug Therapy, Combination; Follow-Up Studies; Heart Transplantation; Heart-Assist Devices; Heparin; Humans; Male; Middle Aged; Monitoring, Physiologic; Myocardial Infarction; Risk Assessment; Severity of Illness Index; Stents; Treatment Failure; Treatment Outcome

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Aortic Aneurysm; Brain Ischemia; Cyanosis; Heparin; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Myocardial Infarction; Risk Factors; Thromboembolism; Thrombosis; Toes; Urinary Bladder Neoplasms

Although the indications for oral anticoagulation (AO) in the treatment of cerebral vascular disease (CVD) are well established, their potential side effects continue to give cause for worry.. To describe the complications and ischemic relapses in patients treated with AO for secondary prevention of CVD of cardiac embolic origin.. We included 169 patients with embologenic cardiopathy who, following an CVD, were treated with AO and followed-up at our medical centre for at least three months. We recorded their past clinical history and risk factors, occurrence of vascular relapses (VR), complications involving hemorrhage (CH), and data regarding course and follow-up.. During an average follow-up of 50.3 months of a total of 707.9 patient/years, 20 VR (2.8% per year) were recorded; 15 of these were cerebro-vascular and mainly mild. We recorded 59 CH in 41 patients (8.3% per year) of which 6 were considered to be major. There was a 30% drop-out rate from follow-up at our centre, mainly due to death from other causes or to change of referral centre.. There is a low incidence of relapse and of complications (usually mild) following AO for the secondary prevention of CVD of cardio-embolic origin. Efficacy and security are maintained in the long term.

Topics: Acenocoumarol; Administration, Oral; Alcoholism; Anticoagulants; Arteriosclerosis; Atrial Fibrillation; Cardiomyopathy, Dilated; Cohort Studies; Comorbidity; Diabetes Mellitus; Disease-Free Survival; Follow-Up Studies; Heart Valve Diseases; Hemorrhage; Humans; Hyperlipidemias; Hypertension; Intracranial Embolism and Thrombosis; Life Tables; Myocardial Infarction; Recurrence; Risk Factors; Smoking; Spain; Treatment Outcome

One hundred and three patients suffering from recurrent venous thrombosis, recurrent arterial thromboembolism and/or recurrent myocardial infarction and 50 healthy subjects were tested for Hageman factor (FXII) coagulant activity and antigen. Among the 103 patients we identified 15 subjects with FXII deficiency (15%), 3 with protein C deficiency (3%) and 3 with protein S deficiency (3%). Combined FXII and protein C, protein S or antithrombin III deficiency was not observed. The 103 patients were divided into subgroups according to the type of thrombotic complication. Among patients with exclusively recurrent venous thromboembolism 8% (p = 0.153) were deficient in FXII. Among patients suffering from recurrent arterial thromboembolism and/or myocardial infarction, the incidence of FXII deficiency was significantly higher (20%, p less than 0.003). In 67% of the patients with FXII deficiency a positive family history of thrombosis could be established. In contrast, only 32% of all venous and 28% of all arterial thrombosis patients had a positive family history. We believe that reduced levels of FXII should be considered as a risk factor in the development of thromboembolism. Consequently, more attention should be payed to the measurement of FXII when evaluating thromboembolic risk factors especially in cases of recurrent arterial thromboembolism and/or myocardial infarction.

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Ambulatory Care; Factor XII Deficiency; Female; Humans; Male; Middle Aged; Myocardial Infarction; Phenprocoumon; Prevalence; Recurrence; Risk Factors; Thromboembolism

Topics: Acenocoumarol; Coronary Artery Bypass; Coronary Disease; Fibrinolytic Agents; Heparin; Humans; Myocardial Infarction; Postoperative Care; Preoperative Care

Topics: Acenocoumarol; Angioplasty, Balloon; Coronary Vessels; Female; Heparin; Humans; Injections, Intra-Arterial; Male; Middle Aged; Myocardial Infarction; Random Allocation; Streptokinase

Four cases of myocardial infarction after termination of anticoagulant therapy are presented. The controversy on the clinical relevance of the "rebound-phenomenon" is discussed: although laboratory parameters seem to suggest a rebound, the phenomenon may be of clinical importance only in certain subpopulations at risk. In these patients withdrawal of the anticoagulant therapy should be gradual.

Topics: Acenocoumarol; Aged; Coronary Disease; Drug Administration Schedule; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Recurrence; Risk

Topics: Acenocoumarol; Aged; Female; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Pulmonary Embolism

Topics: Acenocoumarol; Heparin; Humans; Myocardial Infarction; Thromboembolism

Topics: Acenocoumarol; Drug Therapy, Combination; Heparin; Humans; Myocardial Infarction; Thromboembolism

Topics: Acenocoumarol; Anticoagulants; Humans; Male; Middle Aged; Myocardial Infarction; Retinal Vessels; Thrombosis

Anticoagulation therapy with acenocoumarin or with anticoagulants plus aspirin was given to 65 and 57 patients, respectively, with cardiac valve replacement. The follow-up was 1,462 months (22.5 months per patient) for the first group and 1,411 months (24.7 months per patient) for the second group. The frequency of embolic accidents was significantly lower in the group taking aspirin: Thirteen thromboembolic accidents were detected in patients receiving the anticoagulant and 3 in the group receiving the anticoagulant plus aspirin. These figures represent a 20.3 per cent incidence (one each 9.3 years of treatment) for the anticoagulant group and a 5.2 per cent incidence (one accident each 39.1 years of treatment) for the other group. The statistical significance between groups is p less than 0.005. There was no difference in the hemorrhagic risk between the two groups. We conclude that the use of an anticoagulant plus aspirin is a good and safe therapy for the prevention of thromboembolism in these patients.

Topics: Acenocoumarol; Anticoagulants; Aspirin; Blindness; Drug Therapy, Combination; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Humans; Intracranial Embolism and Thrombosis; Male; Myocardial Infarction; Postoperative Complications; Thromboembolism

Topics: Acenocoumarol; Adolescent; Adult; Age Factors; Aged; Ambulatory Care; Cerebrovascular Disorders; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Myocardial Infarction; Netherlands; Phenprocoumon; Postoperative Complications; Thrombosis

Topics: Acenocoumarol; Adult; Aged; Arteriosclerosis; Dicumarol; Female; Humans; Male; Middle Aged; Myocardial Infarction; Thromboangiitis Obliterans; Transaminases

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Blood Coagulation Tests; Coronary Disease; Coumarins; Dicumarol; Female; Humans; Long-Term Care; Male; Middle Aged; Myocardial Infarction; Recurrence

Topics: Acenocoumarol; Epistaxis; Humans; Male; Middle Aged; Myocardial Infarction

Topics: Acenocoumarol; Adult; Aged; Alopecia; Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Coumarins; Dosage Forms; Drug Synergism; Female; Hemorrhage; Heparin; Heparinoids; Humans; Liver; Male; Middle Aged; Myocardial Infarction; Protamines; Thrombophlebitis; Thrombosis; Time Factors

Topics: Acenocoumarol; Adult; Aged; Ambulatory Care; Embolism; Female; Hemorrhage; Humans; Hungary; Male; Middle Aged; Myocardial Infarction; Physician-Patient Relations; Socioeconomic Factors; Thrombosis

Topics: Acenocoumarol; Adrenal Gland Diseases; Hematoma; Heparin; Humans; Male; Middle Aged; Myocardial Infarction

Topics: Acenocoumarol; Adult; Aged; Angina Pectoris; Anticoagulants; Coronary Disease; Coumarins; Female; Heart Diseases; Heart Valve Diseases; Heart Valve Prosthesis; Hemorrhage; Humans; Long-Term Care; Male; Middle Aged; Myocardial Infarction; Phenindione; Prothrombin Time; Thromboembolism

Topics: Acenocoumarol; Hematoma, Subdural; Humans; Male; Middle Aged; Myocardial Infarction; Warfarin

Topics: Acenocoumarol; Anticoagulants; Chronic Disease; Coronary Disease; Female; Humans; Male; Middle Aged; Myocardial Infarction; Thromboembolism

Topics: Acenocoumarol; Angina Pectoris; Chronic Disease; Follow-Up Studies; Humans; Myocardial Infarction

Topics: Acenocoumarol; Aminopyrine; Anticoagulants; Blood Pressure Determination; Heparin; Intracranial Embolism; Intracranial Embolism and Thrombosis; Liver Function Tests; Myocardial Infarction; Phenylbutazone; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Thrombosis; Toxicology

Topics: Acenocoumarol; Anticoagulants; Hemorrhage; Myocardial Infarction; Pericardial Effusion; Pericarditis; Surgical Procedures, Operative; Toxicology

Topics: Acenocoumarol; Delivery, Obstetric; Female; Humans; Labor, Obstetric; Myocardial Infarction; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Tests; Capillary Resistance; Drug Therapy; Equipment and Supplies; Myocardial Infarction; Prothrombin; Thrombophlebitis; Toxicology

Topics: Acenocoumarol; Anticoagulants; Arrhythmias, Cardiac; Embolism; Humans; Myocardial Infarction; Pulmonary Embolism; Thrombophlebitis

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Tests; Coumarins; Drug Therapy; Embolism; Heparin; Humans; Hungary; Myocardial Infarction; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Angina Pectoris; Anticoagulants; Electrocardiography; Humans; Myocardial Infarction; Prothrombin

Topics: Acenocoumarol; Coagulants; Coronary Disease; Ethyl Biscoumacetate; Geriatrics; Myocardial Infarction; Prothrombin Time; Toxicology

Topics: Acenocoumarol; Dipyridamole; Electrocardiography; Geriatrics; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Hypertension; Myocardial Infarction; Niacin; Occupational Therapy; Papaverine; Psychology; Rehabilitation; Social Work; Thiamine

Topics: Acenocoumarol; Anticoagulants; Heparin; Humans; Myocardial Infarction; Prothrombin Time; Thromboembolism

Topics: Acenocoumarol; Cardiovascular Diseases; Cerebellum; Coumarins; Myocardial Infarction

Topics: Acenocoumarol; Anticoagulants; Coumarins; Myocardial Infarction; Thrombosis